Nursing's Role in Reducing Environmental Health Risks

Introduction: The Nurse's Environmental Duty

According to the International Council of Nurses' position statement on "The Nurse's Role in Safeguarding the Human Environment" (1986), a nurse always has a professional duty to apply his or her trained observational skills to detect the ill effects of the environment on the patient, observe individuals in all settings for the possible negative effects of environmental pollutants, and record and analyze observations about the ill effects of the environment and/or pollutants on individuals. This is not simply to provide better care, but — in keeping with Orem's model of self-care — to facilitate the patient's own sense of competence and to advise the patient on protective and curative measures to mitigate his or her exposure to dangerous substances.

Note the stress upon all environments: it is not enough to make sure that the patient is safe in the hospital or doctor's office. The nurse must provide advice on how to make the acts of daily self-care as free from risk as possible, in the patient's home, work, and leisure environment.

Orem's Self-Care Model and Environmental Awareness

Orem described the patient's environment as a combination of the physical, chemical, biologic, and social conditions relevant to self-care requisites and basic conditioning factors of patient health (Green et al., 2003, p. 3). As the chance of exposure to chemical and environmental toxins increases, so must nurses' vigilance and awareness about these toxins, so they can better inform their patients of the risks and so patients can deploy appropriate risk-mitigation strategies. Environmental diseases may be traced to such factors as the patient's occupation, ambient air pollution, indoor air pollution, exposure to chemicals, radiation, climate change, noise, solid waste, and contaminated water and food (Green et al., 2003, p. 1).

Pesticides, Dioxins, and Dietary Toxins

Toxic risks may come from unexpected, seemingly harmless sources, such as gardening supplies, food, and the air itself. According to Barbara A. Sattler, writing in Georgia Nursing: "Many commonly used pesticides in agriculture, and even those used for homes and gardens, have not been sufficiently evaluated for their effects on human health — carcinogenicity, reproductive or neurological risks." Dioxins are a family of highly toxic chemical compounds created during the combustion of chlorine compounds. Dioxins mimic human hormones and can thus create a range of potential dysfunctions in the human body — reproductive, neurological, and immunologic. They are also carcinogenic. Consumer Reports has tested baby food meat products and found them to have dioxin levels 100 times the Environmental Protection Agency's allowable amount (Sattler, 2004–2005, p. 1).

The National Research Council (NRC) estimates that by age 12, most children in the U.S. will already have been exposed to 50% of their lifetime's total pesticide exposure. Using organic products can minimize such exposure, as can limiting the consumption of antibiotic-containing animal meats (Sattler, 2004–2005, p. 1). During its June 2004 convention, the ANA passed a resolution calling for the cessation of non-therapeutic antibiotic use in animal production and demanding that producers disclose when antibiotics are used (Sattler, 2004–2005, p. 2).

Unfortunately, the nurse must be aware that not all patients can afford a refrigerator full of organic produce and meats. However, the nurse can assist patients by identifying which produce is more likely to be contaminated and which products to avoid when building a healthy diet. Limiting the consumption of fish known to contain high levels of mercury — especially for toddlers, the elderly, pregnant women, and persons with compromised immune systems — is one important step. The nurse can also direct patients toward readily available and reliable sources of data, so that patients can make better lifestyle choices after leaving the nurse's care.

Conclusion: Nurses as Environmental Health Educators

The Orem model is especially useful because it stresses the need for nursing intervention to ideally initiate a new program of improved self-care for the patient in acts of daily life, including environmental monitoring of avoidable toxins and dietary alteration. The nurse facilitates increased self-care by providing knowledge. Because a patient will never have perfect knowledge of all possible risks to his or her health from toxins, the nurse holds a critical role as an educator. As the risks from environmental toxins continue to escalate, so too will the nurse's role in both patient education and patient monitoring.